| Course | NR 325 Adult Health II |
|---|---|
| Week | 4 |
| Paper type | Cardiac case response |
| Length | About 1,100 words, 4 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 325 Week 4
Cardiac Case Response: A 69-Year-Old Woman With Heart Failure Who Looks Settled in Bed and Is Not, Answered Part by Part
Student Name
College of Nursing, Chamberlain University
NR 325: Adult Health II
Instructor Name
Month Day, Year
Cardiac Case Response: A 69-Year-Old Woman With Heart Failure Who Looks Settled in Bed and Is Not, Answered Part by Part
The Case in Brief
Mrs. A., 69, spent 30 years as a dental receptionist and now lives alone with heart failure with reduced ejection fraction, 25% on her last echocardiogram, and permanent atrial fibrillation. She was admitted three days ago with breathlessness and swollen legs and has been on intravenous furosemide 40 milligrams twice daily. At rest in bed this morning her heart rate is 88, blood pressure 118/70, respiratory rate 20 and oxygen saturation 95% on 2 liters by nasal cannula. The case asks four questions, answered below in order.
Part 1: What Do the Figures Tell You About Her Heart Under Load?
The resting figures look acceptable, and on their own they would suggest she is improving. The case also gives a set taken after she washed at the sink with help this morning, and those are the figures that answer the question. After about 6 minutes standing at the sink, her heart rate was 124, irregular; her respiratory rate 30; her oxygen saturation 89% on the same 2 liters; and she said she could not finish a sentence. It took 9 minutes sitting in the chair for her heart rate to return below 100 and her saturation to reach 93%.
Read in pairs, the figures show a heart that manages lying still and cannot meet a small increase in demand. A rise of 36 beats a minute and a fall of 6 points in saturation with washing at a sink is not the response of a patient ready for home, where she lives alone and does her own cooking. The recovery time matters as much as the peak: 9 minutes to settle after 6 minutes of light activity means the next activity, walking to the bathroom, would start before she had recovered from the last. The same resting heart rate of 88 on day 1 was paired with a rise to 132 after sitting on the commode, so there has been some improvement, but it is smaller than the resting figures suggest.
Part 2: What Is Her Fluid Balance?
The case gives intake and output by day. Taken one day at a time, day 2 and day 3 look reasonable: she was only slightly positive each day. Added up, they tell a different story.
Table 1
Fluid Balance and Weight Over Three Days
| Day | Intake (mL) | Output (mL) | Daily balance (mL) | Running total (mL) | Morning weight (kg) |
|---|---|---|---|---|---|
| Admission | 84.0 | ||||
| 1 | 1,800 | 3,100 | -1,300 | -1,300 | 82.9 |
| 2 | 2,200 | 1,900 | +300 | -1,000 | 83.2 |
| 3 | 2,400 | 1,600 | +800 | -200 | 83.6 |
Note. Intake includes oral fluid and intravenous fluid with medicines. Weights are standing, before breakfast, on the same scale.
After a good first day, when she lost 1.3 liters and 1.1 kilograms, she has regained most of it. Her running total is now only 200 milliliters negative after three days of intravenous diuretic, and her weight has risen on each of the last two mornings, from 82.9 to 83.6 kilograms. Her output has fallen each day while her intake has risen, partly because she has been drinking more as she feels thirsty. She is not losing fluid; she is gaining it back.
Part 3: Is the Diuretic Working?
The falling output on the same furosemide dose suggests her response to the diuretic is weakening. A position statement from the Heart Failure Association of the European Society of Cardiology recommends checking diuretic response early after each intravenous dose, using the urine sodium about two hours after the dose or the hourly urine output over the first six hours, and increasing the dose when the response is insufficient (Mullens et al., 2019). The case records her output after this morning's dose at 70 milliliters an hour for the first four hours, which is below the level that statement describes as adequate. Her rate-controlling medicine, metoprolol succinate, was continued at her home dose, which is appropriate for a patient with atrial fibrillation who is not in shock; the question for the team is not rate control but decongestion.
Part 4: Priorities for Today
1. Report the trend in fluid and weight, not today's balance alone: "She is only 200 milliliters negative after three days and has gained 0.7 kilograms in two days; output after this morning's dose is 70 an hour." Request a review of the diuretic dose and a spot urine sodium after the next dose.
2. Measure her under load again after any change: repeat the sink or bathroom walk with oximetry and heart rate before and after, and record the time to settle. Heidenreich et al. (2022) recommend that patients hospitalized with heart failure are assessed for congestion before discharge; the exertional figures are the most useful measure of it on this unit.
3. Fluid and weight: strict intake and output with a running total on the whiteboard, daily standing weight, and a conversation with Mrs. A. about the thirst, with the team's fluid plan.
4. Pace her activity: chair rest between activities, sitting to wash, bedside commode for now, with oxygen increased by protocol if her saturation falls below 90% during activity.
What the Case Teaches About Reading a Heart
Every figure in the resting column of this case is within a range a nurse would accept, and on a busy day the chart would read as a patient who is steadily improving. The two things that contradict that reading are both easy to miss. The first is that the useful figures only exist if someone takes them during activity, which means deliberately measuring a patient while she washes or walks rather than waiting until she is back in bed and settled. The second is that the fluid problem only exists if someone adds the days together; each daily balance on its own looks modest.
Both habits are cheap. A pulse oximeter clipped on during a wash, with the heart rate and saturation written down at the end and again five minutes later, takes a minute of time. A running total written on the whiteboard beside the daily balance takes less. Without them, Mrs. A. could be discharged on the strength of her resting numbers to a home where she would be standing at a stove within the hour, with a diuretic dose that has stopped working.
References
Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E., Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P., Kittleson, M. M., Lee, C. S., Link, M. S., . . . Yancy, C. W. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18), e895-e1032. https://doi.org/10.1161/CIR.0000000000001063
Mullens, W., Damman, K., Harjola, V.-P., Mebazaa, A., Brunner-La Rocca, H.-P., Martens, P., Testani, J. M., Tang, W. H. W., Orso, F., Rossignol, P., Metra, M., Filippatos, G., Seferovic, P. M., Ruschitzka, F., & Coats, A. J. (2019). The use of diuretics in heart failure with congestion: A position statement from the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure, 21(2), 137-155. https://doi.org/10.1002/ejhf.1369
The Chamberlain NR 325 Week 4 instructions
For Week 4 you answer a cardiac case study's questions in the order they are printed. Expect parts asking what the figures show, how fluid balance is trending, whether treatment is working and what your priorities are, in APA with sources. Answer each part under its own heading. Read figures in pairs, at rest and after activity, because a heart's reserve shows under load. Add up daily intake and output into a running total and set it beside weight. Account for medicines, such as rate-controlling drugs, that change how a figure should be read. Give oxygen readings with the oxygen the person was on. Stay within nursing judgment rather than prescribing.
Inside the NR 325 Week 4 example
The response briefly states the case: Mrs. A., an ejection fraction of 25 percent, permanent atrial fibrillation and three days of IV furosemide. Part 1 pairs resting readings with readings after six minutes of washing at the sink and the time to settle. Part 2 sets a table of intake, output, daily and running balance and morning weights, showing the gain on the last two days. Part 3 notes falling output on the same dose and the early diuretic response check recommended by Mullens et al. (2019). Part 4 ranks four priorities, starting with reporting the trend, and cites Heidenreich et al. (2022). A closing section explains why the resting column misled.
Reading the NR 325 Week 4 grading rubric
Cardiac case rubrics generally grade accurate interpretation of data, application of heart failure concepts, use of evidence, prioritization and APA, part by part. Interpretation of paired figures carries the most points, since the question is about a heart under load. Fluid analysis earns credit when daily entries become a running total set against weight. Evidence scores when the diuretic response guidance and heart failure guideline support specific claims. Prioritization is graded on order and specificity, such as a scripted report of the trend. Answering every part under its heading protects completeness. Staying within nursing scope, rather than prescribing doses, matches what this level assesses. Units on every fluid and weight entry protect the data row.
Common NR 325 Week 4 mistakes, and how to avoid them
The biggest loss is a response written entirely from resting figures. Next is fluid reported one shift at a time, so a positive running total goes unnoticed. A morning weight with no earlier weight, a rate-controlling drug ignored, oxygen figures with no flow rate and an answer that moves into prescribing all cost points. You need not name the type of heart failure beyond what the case gives. Use only the exertion figures the case provides. Include enough fluid detail to show the running total. Send the case with its numbered parts, and an NR 325 response can be written part by part. Keep each part's answer under its printed question.
Get a NR 325 Week 4 example written to your instructions
Send the Week 4 case as your section posted it, with the response template or question list attached and any observation record that came with it. We write a custom example into those parts, with every figure tied to what the patient was doing, and return it inside 24 to 48 hours. The first one is free.
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NR 325 Week 4 questions, answered
Does the response need to name the type of heart failure?
Where the prompt asks, one line covers it, and the marks sit elsewhere. What earns them is showing what this heart could and could not manage, which activity produced the change, and what the figures did afterward. A response arriving at a classification and stopping there has answered the pathophysiology question and left the nursing one untouched.
Can I use an exertion figure the case never gave me?
Not as a reading. You can say what you would ask the person to do, what you would measure before and after, and what result would concern you, which reads as method rather than invention. Cases in this week are often trimmed so the resting figures look reassuring, and naming the measurement the case withheld is frequently the strongest line in the document.
How much fluid detail is expected?
Enough for the totals to be checkable: what went in, what came out, over how many days, and the weights alongside. Precision matters more than quantity of writing here. Two lines carrying figures and a total beat a paragraph calling somebody fluid overloaded, because the paragraph cannot be argued with and the totals can.
Where can I find a free NR 325 Week 4 sample paper?
The full Week 4 case response for Mrs. A., with paired resting and activity figures and the three-day fluid table, is reproduced on this page.
What shows the NR 325 Week 4 patient is not settled?
After washing at a sink her heart rate rose by 36 and her saturation fell by 6 points, and her running fluid balance was only 200 milliliters negative after three days while her weight rose.